P5199 - Helicobacter pylori Infection and the Risk of Esophagogastric Variceal Bleeding in Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Meta-Analysis
Nihal I. Khan, MD1, Amna Malik, MD2, Tareq Alsaleh, MD3, Abdullah Javed, MBBS4, Nouman Shafique, MD1, Syed Hamaad Rahman, DO5, Jeevin Singh Sandhu, DO5, Noor Fatima, MD6, Abu Hurairah, MD2, Babu P. Mohan, MD7 1AdventHealth Orlando, Orlando, FL; 2AdventHealth, Orlando, FL; 3Department of Internal Medicine, AdventHealth Orlando, Orlando, FL; 4Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 5Methodist Dallas Medical Center, Dallas, TX; 6Nazareth Hospital, Bensalem, PA; 7Orlando Gastroenterology PA, Orlando, FL Introduction: Helicobacter pylori (H. pylori) is a known cause of non-variceal bleeding in patients with portal hypertension. The role of H. pylori in bleeding from esophagogastric varices in patients with portal hypertension is unclear. We conducted a systematic review and meta-analysis to evaluate the risk of variceal bleeding in patients with portal hypertension and H. pylori infection. Methods: A systematic review of the literature from MEDLINE, EMBASE and Scopus was conducted from inception to May 2025 for studies reporting on the rate of H. pylori infection and variceal bleeding in patients with portal hypertension. Primary outcomes of interest included bleeding from esophageal or gastric varices and H. pylori infection status. Outcomes were expressed as pooled rates and odds ratios with confidence intervals. Standard meta-analysis methods were followed using the random effects model. Heterogeneity was assessed using the I2 statistics. Results: Six single-center studies - three prospective and three retrospective - involving a total of 810 patients were included. 67.0% patients were male, and H. pylori was positive in 459 (56.7%) patients. H. pylori diagnosis was with biopsy in three studies, 13C-urea breath test (13C-UBT) in two studies, and was unspecified in the remaining study. Three studies reported on esophageal plus gastric varices, one on esophageal varices, one on gastric varices, and one did not specify variceal location. The etiology of cirrhosis included hepatitis C in 306 (43.1%), hepatitis B in 219 (30.8%), alcohol in 142 (20%) and others/unknown in 43 (6.1%) cases. Patients with cirrhosis were classified per Child-Pugh score as 190 (30.9%) class A, 278 (45.3%) class B and 146 (23.8%) class C. Baseline characteristics are provided in Table 1.
The pooled incidence of combined esophagogastric variceal bleeding in patients with H. pylori was 56.54% (95% CI: 43.93–68.74; I²=88.1%. The pooled incidence of gastric variceal bleeding in patients with H. pylori was 46.50% (95% CI: 21.10–72.93: I2=90.1%). The pooled odds ratio for variceal bleeding in H. pylori–positive vs. negative patients was 1.51 (95% CI 0.12–18.49; I2=95.7%, P=0.7484). Forest plots are provided in Figure 1. Discussion: Our results suggest that H. pylori may not play a significant role in the risk of variceal bleeding in patients with portal hypertension. Larger, prospective studies are needed to better define the role of H. pylori in variceal bleeding and characterize this based on the anatomical location of varices.
Figure: Table 1. Baseline characteristics
Figure: Figure 1. A: Forest plot of the pooled rate of esophagogastric variceal bleeding in patients with H. pylori infection. B: Forest plot of the pooled rate of gastric variceal bleeding in patients with H. pylori infection. C: Forest plot of the odds ratio of variceal bleeding in patients with and without H. pylori infection
Disclosures: Nihal Khan indicated no relevant financial relationships. Amna Malik indicated no relevant financial relationships. Tareq Alsaleh indicated no relevant financial relationships. Abdullah Javed indicated no relevant financial relationships. Nouman Shafique indicated no relevant financial relationships. Syed Hamaad Rahman indicated no relevant financial relationships. Jeevin Singh Sandhu indicated no relevant financial relationships. Noor Fatima indicated no relevant financial relationships. Abu Hurairah indicated no relevant financial relationships. Babu Mohan indicated no relevant financial relationships.
Nihal I. Khan, MD1, Amna Malik, MD2, Tareq Alsaleh, MD3, Abdullah Javed, MBBS4, Nouman Shafique, MD1, Syed Hamaad Rahman, DO5, Jeevin Singh Sandhu, DO5, Noor Fatima, MD6, Abu Hurairah, MD2, Babu P. Mohan, MD7. P5199 - <i>Helicobacter pylori</i> Infection and the Risk of Esophagogastric Variceal Bleeding in Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
